Marital satisfaction of Chinese mothers of children with autism and intellectual disabilities in Hong Kong

Perceived discrimination among caregivers of children with disabilities in China: Unraveling the effects of social determinants

PURPOSE

Although discrimination has gained increasing attention in research and practice intervention for family caregivers of children with disabilities, little is known about the social determinants that associate with the perceived discrimination among caregivers, especially in non-Western contexts. This study aims to examine the socio-familial and child-level determinants of perceived discrimination among family caregivers of children with disabilities in China.

METHOD

This study drew from a population-based cross-sectional survey in Shenzhen, China. Proportional quota sampling was conducted to get data from 2500 family caregivers of children with disabilities in rehabilitation service centers (response rate = 94.9%, n = 2373), accounting for 25% of the total population of children with disabilities receiving service in Shenzhen. Latent profile analysis was conducted to categorize three perceived discrimination groups among caregivers (i.e., severe perceived discrimination group, moderate perceived discrimination group, and low perceived discrimination group). The multinomial logistic regression models were conducted to test the association between these social determinants and perceived discrimination.

RESULTS

Most caregivers (82.9%) reported moderate or severe levels of perceived discrimination. Caregivers of children with moderate and severe impairments and children with mental and multiple disabilities were more vulnerable to perceiving severe social discrimination. Socio-familial characteristics, particularly the intersectionality between gender and employment, influence caregivers' perceived discrimination.

CONCLUSION

Caregivers of children with disabilities experience pervasive social discrimination in contemporary urban China. Our study demonstrates that the social construction of disablism and the affiliate discrimination against family caregivers of children with disabilities is complex and multidimensional and depends upon the children's disability and the caregivers' socio-demographic characteristics.

Factors Influencing Despair, Self-blame, and Acceptance Among Parents of Children with Autism Spectrum Disorder (ASD): A Malaysian Perspective

PURPOSE

Accepting and adapting to the child's diagnosis of Autism Spectrum Disorder (ASD) can be challenging for parents. We aimed to assess domains of parental adjustment namely despair, self-blame, and acceptance among parents whose children were diagnosed with ASD.

METHODS

A cross-sectional study was conducted among 111 parents of children with autism who attended Child and Adolescent Psychiatry Unit (CAPU), in a university teaching hospital in Kuala Lumpur, Malaysia. Sociodemographic profiles of both parents and children were gathered. Parental adjustment focusing on parental self-blame, despair and acceptance were assessed using self-reported questionnaires namely Adjustment to the Diagnosis of Autism (ADA).

RESULTS

Higher level of despair was associated with parents who have medical illness (β = 0.214, p = 0.016) and children who received antipsychotic medications (β = 0.329, p < 0.001). Parents with tertiary education (β = -0.207, p = 0.023) and those with autistic child attended school (β = -0.200, p = 0.037) have lower level of despair. Parents with medical illness (β = 0.245, p = 0.008), child receiving antipsychotic medications (β = 0.251, p = 0.005), Chinese ethnicity (β = 0.185, p = 0.04), and child's gender (β = 0.283, p = 0.003) were significantly associated with higher level of self-blame. Lower acceptance was found among Chinese parents (β = -0.264, p = 0.005) while married parents had higher acceptance levels (β = 0.215, p = 0.022).

CONCLUSION

Parental adjustment involving domains of despair, self-blame, and acceptance were significantly associated with ethnicity of parents, educational level, parents' marital status and medical illness, as well as the ASD children's schooling status and type of medications used.

Courtesy stigma among primary caregivers of children with autism spectrum disorder in eastern China

Introduction

The experience and perception of stigma is a common problem among primary caregivers of children with autism spectrum disorder (ASD), and has a profound adverse impact on primary caregivers and children with ASD; however, few studies have explored courtesy stigma among primary caregivers of children with ASD in the Chinese context. The aim of this study was to explore the status of courtesy stigma among primary caregivers of children with ASD in Lianyungang, Jiangsu Province, Eastern China, and to conduct in-depth analysis of its predictors from multiple perspectives.

Methods

An institution-based multi-center cross-sectional survey was conducted in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China, from October 2022 to February 2023. A structured questionnaire to assess child-related factors, primary caregiver-related factors, courtesy stigma, general self-efficacy, and social support, was used to collect data. Predictors of courtesy stigma among primary caregivers of children with ASD were identified by linear regression.

Results

A total of 428 primary caregivers of children with ASD were recruited. The mean ± standard deviation (SD) score for courtesy stigma was 7.49 ± 4.13. Multiple linear regression analysis revealed that primary caregivers of children with ASD who were not too satisfied with their current marital status (β = 1.21, 95% CI: 0.34-2.08, p < 0.05) were more likely to have a high courtesy stigma; however, significantly lower courtesy stigma was observed in primary caregivers of children with ASD who were not picky eaters (β = -1.33, 95% CI: -2.08 - -0.58, p < 0.05), and who reported low level challenge in caring for children with ASD (β = -1.16, 95% CI: -2.20 - -0.12, p < 0.05), good general self-efficacy (β = -0.16, 95% CI: -0.25 - -0.06, p < 0.05), and good social support (β = -0.04, 95% CI: -0.08 - -0.01, p < 0.05).

Conclusion

There is a high level of courtesy stigma among primary caregivers of children with ASD in eastern China, and it is affected by numerous factors. More resources should be directed to groups that are more likely to experience stigma.

Self-esteem and family functioning mediates the association of symptom severity and parental affiliate stigma among families with children with ASD

PURPOSE

To investigate the level of affiliate stigma among parents of children with autism spectrum disorder and to explore the mediating role of self-esteem and family functioning.

DESIGN AND METHODS

A cross-sectional study was conducted in a large regional hospital and two childhood rehabilitation centers in Guangdong, China. Data related to demographics, parental self-esteem, family functioning, and affiliate stigma were collected from 180 parents of children diagnosed with ASD. We used t-tests, analysis of variance, and correlation analysis to explore the related factors of parental affiliate stigma. Path analysis was used to determine the mediating roles of self-esteem and family functioning in the relationship between symptom severity and affiliate stigma.

RESULTS

Parents of children with autism spectrum disorder in China experienced low self-esteem, family functioning, and high affiliate stigma. Symptom severity was negatively correlated with self-esteem and family functioning. Self-esteem and family functioning were significantly negatively correlated with affiliate stigma. Symptom severity was positively correlated with affiliate stigma. Self-esteem and family functioning mediated the relationship between symptom severity and affiliate stigma.

CONCLUSIONS

Symptom severity affects parental affiliate stigma among families with children with ASD. Self-esteem and family functioning are the two mediators in the relationship. We should take steps to improve self-esteem and family functioning in order to alleviate parental affiliate stigma.

PRACTICE IMPLICATIONS

This study emphasizes the importance of the influence of ASD severity and family functioning on affiliate stigma. In clinical practice, psychological support should be provided for parents of children with ASD to improve their mental health.

Support Needs and Parent Outcomes in Arab Families of Children with Autism Living in the United Kingdom

Research on the experiences of Arab families of children with autism living in non-Arab countries is scarce. A survey investigated the support needs, psychological distress, and parental relationships of Arab parents (n = 100) of children with autism living in the United Kingdom (UK). The survey consisted of five main questionnaires: a demographic questionnaire, the GO4KIDDS Brief Adaptive Scale, the Family Needs Survey, the Strengths and Difficulties Questionnaire, and the Hospital Anxiety and Depression Scale. Descriptive analysis indicated that the most frequently identified support needs were information, community services, and explaining to others. Parents reported high levels of psychological distress, a high level of parental relationship satisfaction with their spouse, and few parental disagreements about their child with autism. Regression analyses showed that increased child behavior problems predicted more total family needs. Higher levels of child prosocial behavior, the better health status of parents, and a larger number of children in the family were associated with lower levels of parental psychological distress. A longer time living in the UK was associated with more parental disagreement over issues related to the child with ASD. Reducing child behavior problems and increasing child prosocial behavior may be important targets for support and intervention to improve outcomes for Arab parents of autistic children.

A Systematic Review: Acceptance and Commitment Therapy for the Parents of Children and Adolescents with Autism Spectrum Disorder

This systematic review investigated the effectiveness of acceptance and commitment therapy for the parents of children with autism spectrum disorder. PsychInfo, CINAHL, PubMed, Science Direct, and Psychology and Behavioral Sciences Collection were searched using the terms "acceptance and commitment", "autism" and "parent". A total of eight articles met the eligibility criteria. One study was a randomized controlled trial, one was quasi-experimental, and the other six were exploratory. Study outcomes concerned ACT processes, mental health, and quality of life. These studies showed that ACT interventions can be helpful for the parents of children with autism spectrum disorder. Nevertheless, as this field of research is relatively new, future research would benefit from creating a standard procedure and larger randomized controlled trials .

Couples' Experiences of Parenting a Child After an Autism Diagnosis: A Qualitative Study

After a child is diagnosed with autism, parents' relationships are impacted as they reorganize their daily lives to support their child's specific needs. A better understanding of parenting couples' adaptation is needed to accompany them during this period. This qualitative study explored couples' experiences after their child's autism diagnosis. An inductive thematic analysis among ten couple interviews (N = 20) revealed three key themes: emotional experiences, external support, and adaptation. Overall, the quality of couples' relationships before having a child influenced their relationship after the diagnosis. In general, parents presented complementary coparenting roles, while different opinions about how to raise the child strained their relationship. Helping parents adapt to a diagnosis together could prove to be important for future interventions and research.

Developmental stages and estimated prevalence of coexisting mental health and neurodevelopmental conditions and service use in youth with intellectual disabilities, 2011-2012

BACKGROUND

Few studies exist on mental health and neurodevelopmental conditions and service use among youth with intellectual disabilities (IDs), which makes it difficult to develop interventions for this population. The objective of the study is to (1) estimate and compare the prevalence of mental health and neurodevelopmental conditions in youth with and without ID across three developmental stages and (2) estimate and compare mental health service use in youth with and without ID across three developmental stages.

METHODS

We conducted secondary data analysis using cross-sectional data collected from caregivers completing the 2011-2012 National Survey of Children's Health. The data set represents a nationally representative sample of youth (0-17 years) in the USA with one child from each household being randomly selected. Data were collected from caregivers in 50 states, Washington D.C. and the US Virgin Islands. We restricted the sample to parents of youth between 3-17 years (N = 81 510).

RESULTS

Compared with youth without ID, youth ages 3-17 with ID had a statistically significantly higher prevalence of (1) mental health and neurodevelopmental conditions and (2) mental health care use and medication use for mental health and neurodevelopmental issues (other than attention deficit disorder/attention deficit hyperactivity disorder). Clinically significant differences in coexisting conditions and service use were also found across developmental stages.

CONCLUSIONS

Youth with ID are at greater risk of having coexisting mental health and neurodevelopmental conditions than youth without ID and are more likely to receive treatment. Therefore, clinicians should consider mental health and neurodevelopmental conditions and the unique needs of youth by developmental stage when tailoring interventions for youth with ID.

Stigma among parents of children with autism: A literature review

OBJECTIVE

This literature review aims to summarize current findings from studies examined experiences of stigma among parents of children with autism.

METHOD

A systematic literature search was carried out to identify relevant studies. Two reviewers independently screened each records based on the selection criteria. Discrepancies were resolved through discussions. Included articles were classified by social-cultural settings.

RESULT

25 studies were identified and included in the review, including 15 qualitative, 8 quantitative, and 2 mixed method studies. Parents do in fact experience courtesy stigma which subsequently develop into affiliate stigma. The study of stigma has not received enough attention for parents of children with autism. There lacked large prevalence studies and longitudinal studies examining stigma among parents of children with autism.

CONCLUSION

Parents of children with autism perceived and experienced stigma and various consequences which were varied with behaviors of autism and the severity of symptoms. Further studies should focus on developing intervention that help to erase stigma among parents of children with autism.

Affiliate stigma, perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study

BACKGROUND

Affiliate stigma negatively predicts social support, and positively predicts psychological distress, in caregivers of children with ASD. Whether the affiliate stigma-distress relationship occurs indirectly via social support however has not been explored.

METHODS

A correlational design was used. A sample of n = 124 caregivers of children with ASD completed an online survey assessing affiliate stigma, perceived support from family, friends and significant others, and perceived stress.

RESULTS

The relationship between greater affiliate stigma and increased perceived stress occurred indirectly via lower perceived support from family, but not from friends or significant others.

CONCLUSIONS

These findings underscore the importance of increasing caregivers' perceived family support. Whether interventions that alleviate affiliate stigma are beneficial for reducing perceived stress, and whether this effect is mediated by increased perceived availability of support, might be the subject of future research.

Stigma experienced by families of individuals with intellectual disabilities and autism: A systematic review

Studies have investigated the experiences of courtesy stigma and affiliate stigma in family members of individuals with intellectual and developmental disabilities (IDD) without a clear distinction between the two. This systematic literature review aimed to evaluate the findings of studies that examined the experiences of stigma in families of individuals with intellectual disabilities and/or autism. A systematic search of PsycINFO, ERIC and Scopus identified relevant articles published between 2012 and 2016, to expand on an earlier review on this topic published in 2012. Ten articles pertaining to eight studies were identified. They revealed that family carers do experience stigma and various consequences related to these, with family culture influencing these experiences. This review identifies a number of psychosocial variables that are associated with the development of courtesy stigma, affiliate stigma and their consequences. It highlights protective factors and strategies family carers use to cope with stigma, and a lack of clarity in distinguishing the concepts of courtesy stigma and affiliate stigma in family members.

Neuropsychiatric Symptoms, Parenting Stress and Social Support in Chinese Mothers of Children with Autism Spectrum Disorder

Although little is known about the current situation regarding autism spectrum disorder (ASD) in mainland China, psychiatric disorders are common among Chinese mothers of preschool children with ASD. Previous studies showed ASD child's behavioral symptoms, maternal anxiety, and maternal depressive symptoms were associated with overall parenting stress in northern China. In the present study, we retrospectively analyzed medical records at the hospital related to neuropsychiatric symptoms, parenting stress and social support in mothers of children with ASD from southern China. A total of 80 mothers of children with ASD were screened. Among them, 34 mothers were in low-functioning ASD group (L-ASD group) and 46 mothers were in high-functioning ASD group (H-ASD group). Identification of the ASD cases was confirmed with a Revised Autism Diagnostic Inventory. Neuropsychiatric symptoms, parenting stress and social support were measured by neuropsychiatric inventory (NPI), parenting stress index short form (PSI-SF), and multi-dimensional scale of perceived social support (MSPSS). Total mean score of the NPI in the L-ASD group was significantly higher than that in the H-ASD group (P<0.01). The subscale scores of NPI, including depression, anxiety, apathy, irritability, agitation, night time behavior disturbances and change in appetite were significantly higher in the L-ASD group than those in the H-ASD group (P<0.01 or P<0.05). Meanwhile, the total PSI-SF scores and the scores of parental distress (PD), parental-child dysfunctional interaction (PCDI) and difficult child (DC) in the L-ASD group were significantly higher than those in the H-ASD group (P<0.01 or P<0.05). The total score of MSPSS was also higher in the L-ASD group than in the H-ASD group (P<0.01). This study goes further to show the neuropsychiatric symptoms and parenting stress are significantly higher in mothers of children with ASD, and more social supports are needed for mothers of children with ASD from southern China, especially for mothers of children with low-functioning ASD.

Caregivers' characteristics and family constellation variables as predictors of affiliate stigma in caregivers of children with ASD

Affiliate stigma is one risk factor for psychological distress in familial caregivers. Few studies however, and none involving caregivers in the UK and US, have explored caregivers' characteristics and family constellation variables as risk and protective factors for affiliate stigma. This study aimed to fill this gap. Moreover, we believe this study is only second to explore these relationships among caregivers of children with autism spectrum disorder (ASD), a group particularly vulnerable to affiliate stigma. A sample of n = 192 caregivers of children with ASD completed an online survey assessing caregivers' characteristics and family factors, and affiliate stigma. Non-partnered caregivers were more likely to report affiliate stigma, as were caregivers with shorter sleep duration. These findings might help clinicians and other health professionals identify caregivers at risk for affiliate stigma and concomitant psychological distress.

[Impact of moderate intellectual disability on the dynamics and quality of family life: a qualitative clinical study]

This qualitative clinical study investigated the impact of moderate intellectual disability on family dynamics and quality of life. The data were collected using individual interviews with 15 mothers of children with intellectual disabilities, as a convenience sample, and examined with categorical thematic content analysis. The results were discussed using a comprehensive and interpretative approach. Analysis of the interviews showed that care for children with intellectual disabilities is centered on the mother, contributing to the change in family relations. Religious coping appeared as a common strategy for adjusting. Children with intellectual disabilities had less access to services and support than they needed in the areas of health, education, and leisure. Financial constraints and difficulties in community living had a negative impact on the quality of family life. Emotional and psychological support for all the family members, and practical and social support, including income distribution and access to adequate services, proved essential for the well-being of children with intellectual disabilities and their families.

A qualitative study protocol of ageing carers' caregiving experiences and their planning for continuation of care for their immediate family members with intellectual disability

BACKGROUND

Understanding the difficulties and needs of the family carers in taking care of a person with ID can facilitate the development of appropriate intervention programmes and services to strengthen their caring capacity and empower them to continue with their caring roles. This study aims to explore ageing family carers' caregiving experiences and the plans they have to provide care for themselves and their ageing children with mild or moderate intellectual disability (ID).

METHOD

A constructivist grounded theory will be used to interview around 60 carers who have a family member with mild or moderate ID and attending sheltered workshops in Hong Kong. Constant comparative analysis methods will be used for data analysis.

DISCUSSION

The theory will capture family caregiving experiences and the processes of carers in addressing caregiving needs, support received and plans to continue to provide care for themselves and their relatives with ID in their later life. New insights into the emerging issues, needs and plights of family caregivers will be provided to inform the policies and practices of improving the preparation for the ageing process of the persons with ID, and to better support the ageing carers. The theoretical framework that will be generated will be highly practical and useful in generating knowledge about factors that influence the caregiving processes; and, tracking the caregiving journey at different time-points to clearly delineate areas to implement practice changes. In this way, the theoretical framework will be highly useful in guiding timely and appropriate interventions to target at the actual needs of family carers as they themselves are ageing and will need to continue to take care of their family members with ID in the community.

Parental relationship satisfaction in families of children with autism spectrum disorder (ASD): A multilevel analysis

Caring for a child with Autism Spectrum Disorder (ASD) has been linked to a range of negative outcomes for parents but less is known about the putative impact upon the parental couple relationship. The relationship satisfaction of parents of children with ASD was investigated using multilevel modeling. Mothers and fathers (146 couples) reported on their relationship satisfaction, their own well-being, and the behavior problems of the child with ASD and a sibling. Results indicated that mothers and fathers reported similar levels of relationship satisfaction and it was significantly and negatively associated with parental depression and the behavior problems of the child with ASD. Relationship satisfaction was unrelated to the behavior problems of a sibling, the number of children in the household, and family socioeconomic position (SEP). Further longitudinal research that captures a broader range of variables is required to build a theoretical understanding of relationship satisfaction in families of children with ASD. Current evidence suggests that early intervention routes targeting either child behavior problems, parental mental health, or the couple relationship have the potential to benefit inter-connected subsystems within the broader family system. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1259-1268. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

The influence of self-esteem and social support on the relationship between stigma and depressive symptomology in parents caring for children with intellectual disabilities

BACKGROUND

This study explored the synergistic relationship between stigma, self-esteem and social support, as predictors of depressive symptomology in parents of children with disabilities (e.g. Autism and Down syndrome).

METHOD

One hundred and seventy-three parents (115 parents of children with disabilities and 58 control parents) completed measures of perceived stigma, self-esteem, social support and depressive symptoms.

RESULTS

Parents of children with disabilities reported more depressive symptomology; additionally, stigma, self-esteem and social support were associated with depressive symptomology. Moreover, the association between stigma and depressive symptomology was mediated by self-esteem, i.e. parents who reported higher stigma were lower on self-esteem and more depressed. Further, this path varied as a function of emotional support.

CONCLUSION

Results highlight the need for tailored interventions that offer parents effective strategies in dealing with stigma through social support and self-esteem.